Healthcare Provider Details

I. General information

NPI: 1285781732
Provider Name (Legal Business Name): GENESEE COUNTY COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S DORT HWY
FLINT MI
48503-2852
US

IV. Provider business mailing address

2212 WINDEMERE AVE
FLINT MI
48503-2258
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801060672
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6801060672
License Number StateMI

VIII. Authorized Official

Name: MS. LISA LYNN RUDNICK
Title or Position: SUPERVISOR
Credential: LMSW
Phone: 810-257-0092